In 2005, Senate Bill 899 eliminated the old permanent disability rating system and switched to the AMA Guides to the Evaluation of Permanent Disability. As a result, there was a substantial change in the way permanent disability was evaluated, as it addressed the issue of the “ability to compete on the open labor market” concept. In Chapter 1.9, the AMA Guides identified the need for specialized experts who can accurately determine an individual’s ability to compete in the open labor market. Vocational experts were identified.
Vocational experts are responsible for participating in the determination of an injured worker’s ability to compete on the open labor market by providing specific information based upon a comprehensive analysis of that individual’s acquired skills and skills that transfer, given the vocational impact of medical impairments. The job analysis and transferable skills analysis process are specific, evidence-based tools that extract that information.
The evaluation process utilized by medical experts must meet specific standards to be considered substantial medical evidence. Essentially, their opinions must be supported by factual evidence from the review of medical information, examination of the injured worker, testing as appropriate, and grounded in established medical criteria. Physicians conduct their evaluations, diagnose medical conditions, and establish medical impairments based upon the AMA Guides for Permanent Disability in the form of whole person impairments. Whole person impairments as determined by the AMA Guides are based upon activities of daily living.
Evidence-based vocational evaluations are specifically designed to meet the criteria documented by case law, and the documented requirements of the WCAB system. Criteria utilized to determine substantial medical evidence were applied to the vocational evaluation process. This vocational evaluation process is designed to identify medical factors of disability as documented in medical evaluations. Medical examinations, testing, diagnosis, and identification of medical impairments were used as the foundation for identifying a residual vocational profile of the injured worker. Combined with the results of the vocational evaluation process, the resulting findings and conclusions were used to develop opinions regarding the injured worker’s ability to engage in competitive employment, given the vocational impact of the industrial injury. This involved the formalization of the process from the initial measurement criteria (what do I intend to measure), analysis of medical factors of disability, vocational assessment, and the critical analysis process required to establish my professional findings and conclusions that were based upon medical and vocational facts.
Standardized measurement tools are used to measure cognitive and academic functioning, which was supplemented by a situational assessment, a criterion-referenced measurement system. This allowed for a consistent reproducible process that can be adjusted to each individual evaluee. The issue of cause of vocational disability and apportionment of the disability to the industrial injury is based upon case law and the input from legal experts in the field.
Vocational evaluations must accurately and consistently measure medical and vocational factors to determine the two most significant issues: 1. Can this individual work (are they employable) which should include the facts to support how and why. 2. If they can work, then facts must be presented to support how and what work found on the open labor market are they able to do, which is supported by a determination of residual earning capacity.
Vocational experts must “follow the thread” to arrive at evidence-based vocational conclusions. We start with the evaluation, findings, and conclusions of the medical experts. Their medical evidence is the foundation from which the vocational expert conducts the evaluation. They identify medical impairments and determine loss of functional ability. The vocational expert must consider all of the medical evidence and convert medical factors of disability into vocational factors of disability. There must be a clear connection between the medical evidence (ALL medical evidence) and the vocational evidence. The vocational expert must depend upon the evaluating physician’s medical findings, conclusions, and opinions regarding the injured worker to accurately determine that injured worker’s ability to access the open labor market, given the impairments resulting from the industrial injury.